Bankers have a lot of sayings to describe the financial world; I hear them because my husband works in finance. One of my favorites, attributed to Warren Buffett, is “You only find out who is swimming naked when the tide goes out.”

It’s dizzying, as I go round and round with my patients about COVID vaccination. I’ve heard all the reasons for why a patient doesn’t want to be vaccinated. I come prepared with my evidence-based rationale. Back and forth we go.

The current COVID surge has been the hardest of all. Like many of my colleagues, I was physically and emotionally spent before it even began. But more than the exhaustion, what’s made it so difficult for me is that it didn’t have to happen. We have a safe and effective vaccine that’s widely available. While vaccinated individuals may still be infected, they make up a small number of people requiring hospitalization and ICU care. In advocating for vaccination, it feels like healthcare workers have become public enemies.

The man sits comfortably on three liters of nasal canula as I peer into his ED room.

He laughs as I enter with a mask, a face shield, a gown and gloves: all standard protocol for “PUIs,” patients under investigation for COVID. He has good reason to laugh. I look ridiculous.

“You scared of me ol’ boy?” he states in the familiar rural twang of our region.

“Shoot, I ain’t scared. I believe I could whoop you without wrinkling my dress here!”

We both laugh. He can hear I grew up close by.

“Saturation” is a word used to describe an overcrowded hospital, where every bed is full, as is every gurney in the emergency department and every waiting room—and there’s a line of ambulances waiting outside to offload still more patients.

“Saturation” also refers to a swelling riverbed, to color devoid of light, and to the cotton-rag–like lungs of someone with COVID pneumonia.

It’s been almost nineteen months since the first case of COVID was declared in the United States. Since then, health-care workers have endured surging cases, periods of eerie calm, more surges, and, now, a hurricane.

As a person, a student, and a teacher, I have always played by the rules (or even the suggestions) set by authority figures. Even if a rule irks me—I do not like being confined by a seatbelt, for example—I follow it. The Surgeon General’s advice that cigarettes can be lethal made even the thought of lighting up seem like a sin, and I have never smoked. So when scientists stated that vaccines would help in the fight against COVID-19, I got my two doses of Moderna.

Dear Pulse readers,

Over the last few days, I’ve had two conversations with individuals who have decided not to get vaccinated against the COVID virus. In both of those conversations, I struggled.

The first was with a patient whose wife is battling cancer, is receiving chemotherapy and is also unvaccinated.